Gastrointestinal complications of solid organ and hematopoietic cell transplantation

Solid organ transplantation (SOT) and hematopoietic cell transplantation (HCT) have dramatically improved the survival and quality of life in patients with a variety of malignancies and chronic end - organ disease. Gastrointestinal (GI) complications occur in almost 40% of solid organ recipients, and similarly account for many of the non - allograft - related adverse outcomes in the HCT population. GI disorders are frequently present prior to transplant and immunosuppression may augment symptoms. Immunosuppressive drugs also have notable GI side effects, and immunosuppression predisposes patients to infections and malignancies of the liver and GI tract. Graft - versus - host disease presents with GI manifestations and can occur following SOT but is more frequently seen after HCT. Sinusoidal obstruction syndrome (SOS), also known as veno - occlusive disease (VOD), an immunosuppression regimen - related toxicity, has been reported in SOT, but is also more often seen in the HCT population. GI complications are a prevailing source of morbidity and mortality in solid organ and bone marrow transplant recipients. The gastroenterologist should have a broad clinical approach to these complex patients with a low threshold for endoscopy as histopathology is often necessary for diagnosis and management of these patients.